Voluntary HIV Counseling and Testing:

Facts, Issues & Answers

Contents

• New Choices: Medical Care Offers Benefits to People with HIV Infection and AIDS
• What is HIV, and How Could I Become Infected?
• What Happens If I Become Infected with HIV?
• The Best Way to Know Whether You Are Infected: HIV-antibody Counseling and Testing
• Should I Seek Counseling and Testing?
• Risk Checklist
• Reasons for Seeking Counseling and Testing
• Reasons for Not Seeking Counseling and Testing
• Understanding HIV Counseling and Testing
• Deciding Where to Go for Counseling and Testing
• The Process of Counseling and Testing
• The Meaning of Your Test Result
• How A Positive Test Result Might Affect Your Life
• Answers to Your Questions

NEW CHOICES: HIV AND AIDS MEDICAL CARE OFFERS VITAL BENEFITS

There are clear benefits to early medical attention for infection with the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS).

If you are infected with HIV, the virus slowly weakens your ability to fight illness. But medical treatments, including medicines and earlier use of medications, can help your body resist the virus. They do this by slowing the growth of HIV and delaying or preventing certain life-threatening conditions.

For example, some medicines can prevent the type of pneumonia that is a common problem for people who have HIV or AIDS. Doctors can also find out when your immune system begins to weaken. By evaluating your immune system on a regular basis and vaccinating you against bacterial pneumonia and influenza, doctors can help you avoid illnesses related to HIV infection and treat them more effectively when they occur. Without the help of medical care your body may develop serious illnesses more quickly. For pregnant women, medical treatment with AZT (zidovudine) may reduce the chances of your baby being infected with HIV.

It is important that you consider these medical options as you decide whether to seek counseling and testing for HIV infection. Deciding whether to seek counseling and testing can be very hard. Your choice can have a major impact on your life. Medical options have increased the benefits of counseling and testing. This brochure gives you the information you need to understand these benefits and consider them with other issues important to you. Use this brochure to make the choice that is right for you.

WHAT IS HIV, AND HOW DO I BECOME INFECTED?

HIV, the human immunodeficiency virus, is the virus that causes AIDS. HIV is mainly transmitted by contact with the blood, semen, or vaginal fluids of infected people. The HIV-infected person can infect others, even if no symptoms are present.

HIV is transmitted by:

• Having unprotected sex-vaginal, anal, or oral-with an infected person. Unprotected sex is sexual intercourse without consistent and correct condom use.
• Using or being stuck with a needle or syringe that has been used by or for an infected person.
• Giving birth-Women with HIV infection can pass the virus to their babies during pregnancy or childbirth. In some cases, they can also pass it on when breast-feeding.
• Receiving blood- Some people have been infected by receiving blood transfusions. However, the risk of infection through blood transfusions has been practically eliminated since 1985 when careful and widespread screening and testing of the blood supply for evidence of HIV became standard practice.

WHAT HAPPENS IF I BECOME INFECTED WITH HIV?

Being infected with HIV does not always mean you have AIDS. Being infected means the virus in your body for the rest of your life. Therefore, you can infect others if you engage in behaviors that can transmit HIV. You can infect others even if you feel fine and no symptoms of illness are present. You can infect others even if you do not know you are infected.

HIV weakens your body's immune system. This means that HIV infection can make your body more and more vulnerable to other illnesses and infections over time. Early symptoms may include tiredness, fever, diarrhea, enlarged lymph nodes, loss of appetite, or night sweats. People with HIV infection can develop many different health problems. These include severe pneumonia, several forms of cancer, damage to the brain and nervous system, and extreme weight loss. These conditions signal the onset of AIDS, the most serious stage of HIV infection. Virtually all people with HIV infection will develop AIDS, but, with treatment, the HIV infection can usually be slowed and the onset of AIDS can be delayed.

How fast does HIV infection develop into AIDS? In some people, AIDS-related illnesses may develop within a few years. Without treatment, half of HIV infected people will develop an AIDS-related illness within 10 years. To stay healthy for as long as possible, it is important to learn your HIV status, obtain medical advice, monitor your health, and consider your treatment options.

THE BEST WAY TO KNOW WHETHER YOU ARE INFECTED: HIV-ANTIBODY COUNSELING AND TESTING

You cannot tell by looking at someone whether he or she has HIV infection. Someone can look and feel perfectly healthy and still be infected. Many people who have HIV infections do not know it. Neither do their sex partners.

The HIV-antibody test is the only way to tell whether your are infected. When any virus enters your body, your immune system responds by making proteins called antibodies. Different viruses cause the body to make different antibodies. You make antibodies to HIV when you have HIV infection. The HIV-antibody test detects HIV antibodies in your blood. It tells you whether you are infected with HIV. The test does not tell you if you have AIDS or when you will get AIDS. HIV antibodies are a sign of infection, but, unlike antibodies for many other infections, they do not protect your body from disease. They do not protect you from AIDS, do not make your immune, and do not prevent you from giving HIV to someone else.

The HIV-antibody test should always include before-test and after-test counseling. This counseling is to help you understand your result, how to protect your own health, and (if you are infected) how to keep from infecting other people. It is a central part of the testing process whether you are infected or not.

SHOULD I SEEK HIV COUNSELING AND TESTING?

AT RISK

There is evidence that HIV, the virus that causes AIDS, has been in the United States at least since 1978. The following are known risk factors for HIV infection. If you answer yes to any of these questions, you should definitely seek counseling and testing. You may be at increased risk of infection if any of the following apply to you since 1978.

• Have you shared needles or syringes to inject drugs or steroids?
• If you are a male, have you had unprotected sex with other males?
• Have you had unprotected sex with someone who you know or suspect was infected with HIV?
• Have you had a sexually transmitted disease (STD)?
• Have you received a blood transfusion or clotting factor between 1978 and 1985?
• Have you had unprotected sex with someone who would answer yes to any of the above questions?

If you have had sex with someone and you didn't know their risk behavior, or you have had many sex partners, then you have increased the chances that you might be HIV infected.

If you plan to become pregnant, counseling and testing is even more important. Without treatment, HIV-infected women have about a one-in-four chance of infecting their baby during pregnancy or delivery. Medical treatment can reduce this to about a 1 in 12 chance.

REASONS FOR SEEKING COUNSELING AND TESTING

People consider counseling and testing for a number of reasons, some of which may apply to you:

• Knowing whether you have HIV infection would alert you to your need to seek medical care to prevent or delay life- threatening illness. Your test result (positive or negative) would also help your doctor determine the cause and best treatment of the various illnesses you may have now or in the future. For example, if you are HIV-positive, tuberculosis (TB) and syphilis are treated differently than if you are HIV- negative.
• If you find out you are infected, knowing your result would help you protect your sex partner(s) from infection and illness. If they are not infected, you can avoid infecting them.
• Knowing your result would help you assess the safety of having a child.
• Knowing your result, even if you are infected (positive test result) may be less stressful for some people than the anxiety of thinking you might be infected but not knowing. If your result indicates you are not infected (negative), you can take action to be sure you don't become infected in the future.

REASONS FOR NOT SEEKING COUNSELING AND TESTING

People may not seek counseling and testing for a number of reasons. For instance, if they are certain they have never engaged in behavior that could infect them with HIV, or had a blood transfusion, they do not need to be counseled and tested. Other reasons are less clear-cut. For instance, they think the stress of a positive test result -- and the issues it would raise among family members, friends, and sex partners -- would be more harmful than not knowing if they are infected. Perhaps they fear that others may find out their result without their permission. They might also be concerned about discrimination; some people have been denied housing, jobs and insurance because they have HIV infection.

Many people are troubled by these concerns. You should decide for yourself whether these concerns outweigh the benefits of testing and early medical attention. The latest medical knowledge gives added weight to the benefits of knowing if you are infected. If you have any doubts about what you should do, get counseling. Then you can decide whether to go ahead with testing. However, if you decide NOT to be tested you should prevent the transmission of any possible HIV in your body to sex or needle-sharing partners.

UNDERSTANDING THE HIV COUNSELING AND TESTING PROCESS

It is very important that you understand the confidentiality policies of the testing center. Ask your testing counselor how they will protect your test results. Most counseling and testing centers follow one of two policies:

Confidential testing

The confidential testing site records your name with the test result. They will keep your record secret from everybody except medical personnel, or in some states, the state health department. You should ask who will know the result and how it will be stored. If you have your HIV antibody test done confidentially you can sign a release form to have your test result sent to your doctor.

Anonymous testing (not available in all state)

No one asks your name. You are the only one who can tell anyone else your result.

If you wish to be tested, ask your health department, doctor, or the CDC National AIDS Hotline (1-800-342-AIDS) about the location of facilities near you.

DECIDING WHERE TO GO FOR COUNSELING AND TESTING

Depending on the area where you live, there are different counseling and testing places from which to choose. These options include publicly funded HIV testing centers, community health clinics, sexually transmitted disease (STD) clinics, family planning clinics, hospital clinics, drug treatment facilities, TB clinics, and your doctor's office. In making your choice, you may want to consider these factors:

• If you have been to a particular place for health care before for other reasons, you may feel more comfortable with the staff who will counsel you and offer you testing.
• If the center can provide immune system monitoring and medical care if you are infected with HIV, it might speed up the beginning of your medical treatment.
• Some counseling and testing centers offer special features. For instance, if you use drugs, you can receive counseling, testing and help for addiction at a drug treatment facility.

At some centers, such as doctor's offices or clinics, information about your test result may become part of your medical record and may be seen by healthcare workers, insurers, or employers. Your status may become known to your insurance company if you make a claim for health insurance benefits or apply for life insurance or disability insurance. If any health care provider proposes to test you for HIV antibodies, discuss the reasons and the potential benefits before deciding whether or not to take the test.

You can call the CDC National AIDS Hotline (1-800-342-AIDS) to get the address of places where you can get counseling and testing. Do not go to a hospital emergency room to be counseled and tested. You should go to an emergency room only if you have a health problem that demands urgent attention. Also, do not give blood at a blood donation center as a way to get tested for HIV antibodies. Blood donation centers are not HIV-antibody counseling and testing centers and should not be used as such.

THE PROCESS OF COUNSELING AND TESTING

COUNSELING

You should be given materials to read before you enter a group or private session with a counselor or doctor. He or she might ask why you want to be tested. Your counselor should also ask about your behavior and that of your sex partner(s). This will help your counselor and you to determine whether testing is appropriate for you. If testing is appropriate, your counselor or doctor should:

• Describe the test and how is done
• Explain AIDS and the ways HIV infection is spread
• Discuss ways to prevent the spread of HIV
• Explain the confidentiality of the test results
• Discuss the meaning of possible test results
• Ask what impact you think the test result will have on you
• Address the question of whom you might tell about your result
• Discuss the importance of telling your sex and/or drug-using partner(s) if the result indicates HIV infection

If these questions are not covered, or if you have any other questions, ask them. You should come prepared with questions that have been on your mind. Also ask your doctor or counselor how you will be told of the test result. If your test result is negative, the post-test counselor will talk to you about how to avoid behaviors that will put you at risk.

INFORMED CONSENT

THE BLOOD TEST

THE WAITING PERIOD

This period of days or weeks can produce anxiety and tension. Some people decide during this time that they do not want to know their test result and never return to receive it. It is very important that you finish the process and find out the test result in spite of your anxiety.

It is also important that until you return for your result and post-test counseling you act as if you were infected and could transmit the virus. In other works, don't have unprotected sex or don't have sex at all and don't share needles.

When your result arrives, you may be asked to return to the counseling and testing center to receive the information in person. Everyone tested should receive counseling, whether the result is positive or negative.

COUNSELING AFTER THE TEST

Your counselor should tell you your result and, regardless of whether it is positive or negative, how to protect your health and the health of others. He or she will review methods to prevent the spread of HIV.

If your result is negative, your counselor may discuss retesting if, during the 6 months before your test, you engaged in any behaviors that might have infected you. You may be infected but your body may not yet have produced enough antibodies for the test to detect. Since it takes time for your body to develop antibodies, you may need to be retested.

If your test is positive, your counselor will tell you what this means for you. Any questions you have should be answered and your counselor will refer you for follow-up health care, support services, or further counseling. Your counselor will also talk to you about telling your sex and/or drug-using partner(s).

TYPE OF TESTS

The ELISA (Enzyme-Linked Immunosorbent Assay) is a screening test that is widely used. It can be performed relatively quickly and easily. If a reactive (so called "positive") result occurs, the test is repeated to check it.

If an ELISA test yields two or more reactive results, a different test such as the Western blot is used to confirm these results as positive for HIV antibodies. The Western blot is more specific and takes longer to perform than the ELISA. Together, the two tests are more than 99.9 percent accurate. Further evaluation can be done if results of repeated ELISA and Western blot tests are unclear. Your testing facility should do the ELISA twice on the same blood sample and confirming test such as the Western blot if the ELISA tests are repeatedly reactive.

THE MEANING OF YOUR TEST RESULT

NEGATIVE RESULT

A negative result means that no HIV antibodies were found in your blood. Your condition is called seronegative. This usually means you are not infected.

Testing negative does not mean you are immune to HIV. No one is immune to HIV. Even if you test negative, there are steps you should take to protect your health and the health of your sex and/or drug-using partner(s). Do not engage in behaviors that can transmit HIV. These behaviors include having sexual intercourse with an infected person or sharing needles or syringes with an infected person. Your post-test counselor will discuss these behaviors with you.

There is a small chance that you may be infected, even though you tested negative. It takes time for the body to develop HIV antibodies after infection. Almost all people develop HIV antibodies within 3 months, but it can take up to 6 months after infection for some persons. If you engaged in behavior that can transmit the virus during the 6 months just before your test, you may be infected but still test negative because your body may not yet have produced antibodies. To be sure, you must be retested at least 6 months after you last engaged in behavior that can transmit HIV.

INDETERMINATE RESULT

Once in a while, test results are unclear. The lab cannot tell whether they are positive or negative, even if the test has been performed correctly. If this happens to you, it is important that you discuss this with your counselor or doctor, and, if appropriate, be tested again. HIV-antibody test results are extremely accurate when proper procedures are followed. However, a very small number of people may test positive even though they are not infected. These are called false positive results. If you do test positive, you should discuss with your counselor or doctor whether retesting a new blood sample is appropriate.

POSITIVE RESULT

A positive result means antibodies to HIV were found in your blood. This means you have HIV infection. Your condition is called HIV-positive, or seropositive. You will most likely develop AIDS, but no one can know when you will get sick. Within 10 years after infection, about half of untreated people have developed AIDS. However, prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions.

If your test result is positive, there are a number of important steps you should take immediately to protect your health.

• See a doctor, even if you don't feel sick. Ask if this doctor has experience treating people with HIV infection and is familiar with AIDS and HIV-related issues. Tell the doctor your test result and discuss immune system monitoring and treatment. Monitoring and appropriate medical action are the ways to slow the growth of HIV and to delay the onset of AIDS.
• Have a tuberculosis (TB) test done. You may be unknowingly infected with TB. You could become seriously ill if your TB goes undetected. TB can be treated successfully if detected early in your HIV infection.
• Ask your doctor if you should get flu vaccine or other vaccines.
• Enroll in a program to help you stop using drugs, drinking a lot of alcoholic beverages, or smoking. This will help you reduce or stop engaging in behaviors that can weaken your body.
• Consider joining a support group for people with HIV infection. Such support can help you cope with being HIV infected.

You should take steps to protect the health of others:

• You may infect others if you engage in behaviors that can transmit the virus (unprotected sexual intercourse-vaginal, anal or oral-or sharing drug needles or syringes).
• To reduce the risk of transmitting HIV if you have sexual intercourse, always use latex or plastic condoms. Use them from beginning to end every time you have sex and make sure to use them properly.
• There is no known risk of infection except in situations where we come in contact with blood, semen, or vaginal fluids.
• If you are a woman, you should understand the risks of pregnancy. Without medical treatment there is about a one-in- four chance that you will pass HIV to your unborn baby. With medical treatment the chance you will pass HIV to your baby can be reduced to 1 in 12. This treatment includes giving AZT (zidovudine) to the woman during pregnancy and labor. The baby must be given AZT for the first several weeks of life. There must be no breastfeeding by the infected mother.
• Do not donate blood, organs, sperm, corneas (eyes), or bone marrow. Revise any organ donor permissions you have given.
• Tell any doctor or dentist who treats you that you are infected.

You should tell anyone with whom you have had unprotected sex (vaginal, anal or oral) or shared needles since 1978 that you are (and they may be) infected with HIV. It is especially important that you tell current and recent partners. Health professionals can tell your sex and/or drug-using partner(s) for your or help you tell them yourself. All of your present and past partners should be referred for counseling and testing. If they are HIV positive, prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. Also, they may unknowingly infect others. You have an important role to play in helping stop the spread of HIV infection.

Telling people about your test result can be a very sensitive matter. You may want to discuss it with your testing counselor. They can assist you in telling your sex or drug-using partners If you choose to tell your partners yourself, do not make accusations. Be prepared for partners to become upset or hostile. Urge them to be counseled and tested as soon as possible. You may want to give them a copy of this brochure.

HOW A POSITIVE TEST RESULT MIGHT AFFECT YOUR LIFE

Being infected with HIV is not only a health matter. It raises financial and social issues as well. One of these issues is insurance. These issues should be discussed with a qualified counselor.

Your ability to pay for health care can effect your access to monitoring and treatment. If you do not have health insurance or if you depend upon Medicaid, you may need special assistance to get treatment.

As of 1994, four drugs that act to slow HIV have been approved for use in the United States. More drugs are being tested. To find out about experimental treatments, call the AIDS Clinical Trials Information Service (1-800-TRIALS-A, that is, 1-800-874- 2572), Monday through Friday between 9 a.m. and 7 p.m. Eastern time. Centers that offer experimental drug treatments for AIDS- related illnesses may not be available everywhere.

Some people who do not understand AIDS may avoid persons who they know are infected with HIV. Some people who are infected have been targets of discrimination in employment, housing and insurance. Some have been deeply hurt by the reactions of friends and family members. You should be prepared to encounter uncomfortable reactions and to deal with these issues. However, the Americans with Disabilities Act (ADA) can protect you from many forms of discrimination, especially on the job, having a place to live, and getting services available to the public.

ANSWERS TO YOUR QUESTIONS

Here are answers to some questions you may have about HIV- antibody counseling and testing.

Why get tested?

If you know you are infected, you can take steps to protect your health and the health of others. There are clear benefits to early treatment, even though there is no cure for HIV infection. Medical options, including medications and other approaches, can help slow the infection and delay or prevent life-threatening conditions.

I think I recently placed myself at risk of infection with HIV. Should I get counseled and tested right away?

If you get infected with HIV, tests may not detect it until a few weeks after infection. The test detects HIV antibodies in your blood. If you are infected, your body takes time to make enough antibodies for the test to measure. It can take as little as 2 weeks. But it might take several months. Nearly all infected people develop antibodies within 3 months of infection. For some persons it may take up to 6 months. If you think you placed yourself at risk for HIV infection, you should get counseling, and until you know you are not infected, you should protect others as if your were infected.

Does it take long to get an appointment to be counseled and tested?

I depends on where you live. Some counseling and testing facilities can schedule appointments very quickly. Others may take a few weeks. Call your local health department for find out.

How much does HIV counseling and testing cost?

Most publicly funded testing sites are free or require only a minimum fee. If you go to your doctor for counseling and testing, the cost may vary. In some areas, it can be more than $200. You can ask the cost beforehand.

When I had blood tests done for my physical, marriage license, or insurance, was I tested for HIV antibodies?

Do hospitals routinely test for HIV infection? You should not assume that your blood was tested for HIV antibodies. If you are concerned, ask your health care provider specifically if your blood was or will be tested for HIV antibodies.

If I'm pregnant or thinking about having a baby, should I be counseled and tested?

If you or your sex or drug partner have engaged in behaviors that can transmit HIV, you should get counseling and testing. If you test positive you should be aware that without treatment there is a one-in-four chance that you will pass the virus to your unborn baby. Medical treatment can reduce this to about 1 chance in 12. If you are already pregnant, you should tell your health care provider you tested positive. This will help your provider care for you and your baby during and after pregnancy.

What if an insurance company wants me to take the test?

An insurance company may require that you be tested for HIV infection if you apply for a health or life policy. You have the right not to take the test. You must choose whether to take the test or find an insurer who will not ask you to do so. If the test is required, either to determine if you will be covered or to set the rates, you may wish to be tested anonymously or confidentially first.

Will my insurer find out if I test positive?

Your insurer will know you took the test if you pay for the test through insurance. Insurers can find out your test RESULT only if you release it. On some insurance forms, your signature authorizes release of medical records. If you are concerned, do not sign medical release forms unless you know their purpose. You may also choose to be counseled and tested at a facility separate from your health care provider. These facilities include publicly funded testing sites, sexually transmitted disease clinics, and family planning clinics. Call your health department or the CDC National AIDS Hotline (1-800-342-AIDS) to find out the nearest facility that offers confidential counseling and testing.

Does the Government keep track of those who test positive?

The U.S. Public Health Services does not record or collect names of people who test positive. The state health departments that do collect names treat this information as highly confidential. Most states have laws against releasing confidential information without permission. Call your state or local health department to find out the laws in your state.

Even though I tested negative, why do I have symptoms?

See a doctor about your symptoms. They are most likely caused by something other than HIV infection. Early symptoms of HIV infection can be similar to the symptoms of many other diseases that occur in people who are not infected with HIV. If you test negative and still think you might be infected, consider retesting. If you test negative again, and you have not engaged in behavior that can transmit HIV in the past 6 months, you are probably not infected with HIV.

My partner tested negative. That means I'm not infected, right?

Your partner's test does not always tell your status. The only way to know whether you are infected is to have your own test.

Can I continue to work if I have HIV infection?

Yes, you can continue working if you have HIV infection. HIV cannot be spread by contact that does not involve blood, semen, or vaginal secretions. Many years after infection, some people still have no symptoms and continue to work productively. In the later stages of HIV infection, illness may cause you to be too sick to work. It depends on your health and your job duties.

How can I find a doctor who will treat me?

Call your local medical society. They should be able to refer you to a doctor who will help you. For additional help, you can contact a local AIDS organization. The people there may be able to help you find a doctor who is experienced with HIV and AIDS-related issues. For the telephone numbers of these organizations, call the CDC National AIDS Hotline [1-800-342-AIDS; Spanish 1- 800-344-7432; Deaf access 1-800-243-7889 (TTY)]

.........................AMERICA RESPONDS TO AIDS

Part of the America Responds to AIDS brochure series, this brochure has been prepared by the Centers for Disease Control and Prevention, U.S. Public Health Service. The Centers for Disease Control and Prevention is the Federal agency responsible for the prevention and control of diseases, including AIDS, in the United States.